MISTY SHADDUCK LPN
NPI 1043080476
Licensed Practical Nurse in Mesa, AZ

Q: What is Misty Shadduck's NPI number?

The NPI number for Misty Shadduck is 1043080476. It was assigned to this individual provider in the NPPES registry on January 5, 2024.

Q: What is Misty Shadduck's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

Q: When was this NPI record last updated?

The NPPES record for Misty Shadduck was last updated on January 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 05, 2024

455 N MESA DR STE 8E, MESA, AZ 85201(937) 768-2544(877) 991-6652 Get Directions Write a Review

NPPES record last updated: January 5, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Misty Shadduck Lpn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISTY SHADDUCK LPN (NPI 1043080476) is an individual licensed practical nurse in Mesa, Arizona, licensed in Pennsylvania (PN301121) and active in the NPI registry since January 2024.

NPPES Registry Identity

NPI1043080476

Entity TypeIndividualFemale

Primary Taxonomy164W00000X

Provider Legal NameMISTY SHADDUCKCredential: LPN

Location Address455 N MESA DR STE 8EMesa, AZ 85201-5996

Mailing Address70 S Val Vista Dr # A3-618Gilbert, AZ 85296-1374

Phone(937) 768-2544

Fax(877) 991-6652

Sole ProprietorNo

Enumeration DateJanuary 5, 2024

NPPES CertifiedJanuary 5, 2024

✔ NPI 1043080476 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers

Taxonomy Code164W00000X

Licenses✔ Licensed in PA · PN301121✔ Licensed in NY · 32549101

Definition

A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

455 N MESA DR STE 8E, Mesa, AZ 85201

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Misty Shadduck's NPI number?

The NPI number for Misty Shadduck is 1043080476. It was assigned to this individual provider in the NPPES registry on January 5, 2024.

Where is Misty Shadduck located?

Misty Shadduck practices at 455 N Mesa Dr Ste 8E, Mesa, AZ 85201. The listed phone number is (937) 768-2544.

What is Misty Shadduck's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Misty Shadduck was last updated on January 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.